The KSHV viral IL-6 homolog is sufficient to induce blood to lymphatic endothelial cell differentiation

The predominant tumor cell of Kaposi's Sarcoma (KS) is the spindle cell, a cell of endothelial origin that expresses markers of lymphatic endothelium. In culture, Kaposi's Sarcoma-associated herpesvirus (KSHV) infection of blood endothelial cells drives expression of lymphatic endothelial cell specific markers, in a process that requires activation of the gp130 receptor and the JAK2/STAT3 and PI3K/AKT signaling pathways. While expression of each of the KSHV major latent genes in endothelial cells failed to increase expression of lymphatic markers, the viral homolog of human IL-6 (vIL-6) was sufficient for induction and requires the JAK2/STAT3 and PI3K/AKT pathways. Therefore, activation of gp130 and downstream signaling by vIL-6 is sufficient to drive blood to lymphatic endothelial cell differentiation. While sufficient, vIL-6 is not necessary for lymphatic reprogramming in the context of viral infection. This indicates that multiple viral genes are involved and suggests a central importance of this pathway to KSHV pathogenesis.     

PI3K/Akt信号通路及其抑制剂的研究进展

磷脂酰肌醇3激酶（PI3K）/丝氨酸-苏氨酸激酶（Akt）信号通路在信号转导的调控中扮演着重要角色,能调节细胞增殖、凋亡、代谢、运动、血管生成等生物过程。与其他信号通路相比,PI3K/Akt信号通路的组成部分更庞大,在肿瘤中更多见。目前已证实多种肿瘤中存在PI3K/Akt信号通路的超活化,对肿瘤细胞的存活、生长、运动、血管生成和代谢意义重大。因此,抑制PI3K和与通路相关的成分可能会使肿瘤生长受抑,使患者预后改善。PI3K/Akt信号通路抑制剂包括针对单一成分的抑制剂和双重抑制剂。目前大量的PI3K抑制剂已在临床前期研究中取得良好结果,有些已经在血液恶性肿瘤和实体肿瘤中进行了临床试验。在此综述中,我们简单的总结了PI3K-AKt通路的研究成果,讨论了PI3K抑制剂从临床前研究到临床研究的发展前景。     

Regulation of SHP2 by PTEN/AKT/GSK-3β signaling facilitates IFN-γ resistance in hyperproliferating gastric cancer

Oncogenic activation accompanied by escape from immune surveillance, such as IFN-γ resistance, is critical for cancer cell growth and survival. In this study, we investigated the crosstalk signaling between IFN-γ resistance and signaling of hyperproliferation in gastric cancer cells. IFN-γ inhibited the cell growth of MKN45 cells but not hyperproliferating AGS cells. AGS cells did not respond to IFN-γ because of a decrease in STAT1 but not due to dysfunctional IFN-γ receptors. Signaling of PI3K/AKT, as well as MEK/ERK, was required for the hyperproliferation; notably, PI3K/AKT alone mediated the IFN-γ resistance. Aberrant Src homology-2 domain-containing phosphatase (SHP) 2 determined IFN-γ resistance but unexpectedly had no effects on hyperproliferation or ERK activation. In the IFN-γ resistant cells, inactivation of glycogen synthase kinase (GSK)-3β by PI3K/AKT was important for SHP2 activation but not for hyperproliferation. An imbalance of AKT/GSK-3β/SHP2 caused by a reduction of PTEN was important for the crosstalk between IFN-γ resistance and hyperproliferation. PI3K is constitutively expressed in AGS cells and immunohistochemical staining showed a correlation between hyperproliferation and expression of SHP2 and STAT1 in gastric tumors. These results demonstrate the effects of PTEN/AKT/GSK-3β/SHP2 signaling on IFN-γ resistance in hyperproliferating gastric cancer cells.     

NOX-4调控PI3K信号通路参与TGF-β1诱导肺癌细胞表达I型胶原蛋白

 目的：研究NADPH氧化酶4（NOX-4）调控PI3K信号通路在转化生长因子β1（TGF-β1）诱导肺癌细胞表达I型胶原蛋白（collagen I）的作用及分子机制。方法：体外培养人肺癌A549细胞,予TGF-β1刺激后,观察NOX家族和collagen 家族的mRNA和蛋白表达的变化,以及PI3K class I催化亚基的表达和PI3K信号通路活化的变化;NOX-4抑制剂二亚苯基碘鎓（DPI）预先处理肺癌细胞,观察TGF-β1刺激后 collagen I的mRNA和蛋白表达的变化以及PI3K class I催化亚基表达和PI3K信号通路活化。结果：TGF-β1可以诱导肺癌细胞中NOX-4和collagen I的mRNA和蛋白表达升高,并诱导PI3K class I催化亚基中PIK3CD表达升高和PI3K信号通路的活化。NOX-4抑制剂DPI可以抑制TGF-β1诱导的collagen I表达升高;抑制NOX-4并不影响TGF-β1诱导的PI3K催化亚基PIK3CD表达,但可以降低TGF-β1诱导PI3K信号通路的活化程度。结论：NOX-4经调控PI3K信号通路的活化参与了TGF-β1诱导肺癌细胞表达collagen I的分子机制。TGF-β1/NOX-4/PI3K信号通路轴在肺癌细胞collagen I的表达中发挥了调控作用。     

Insulin-like growth factor-I inhibits cell growth in the a549 non-small lung cancer cell line

Insulin-like growth factors (IGFs) are potent mitogenic and antiapoptotic factors for many cell types, including some normal and neoplastic lung cells in vitro. However, in this study we show that IGF-I, at concentrations of 10 ng/ml or greater, significantly inhibits DNA synthesis and cell proliferation in a human lung adenocarcinoma cell line, A549. Inhibition of DNA synthesis was completely reversed by an IGF-I receptor-neutralizing antibody, alphaIR-3, indicating that IGF-I receptor activation is involved in its inhibitory effect. Attenuation of the p44/42 mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3'-kinase (PI 3'-kinase) pathways downstream of the IGF-I receptor using the inhibitors PD98059 and LY294002, respectively, partially reversed IGF-I-induced inhibition. Acute (2-60 min) and chronic (24 h) exposure of A549 cells to 100 ng/ml IGF-I resulted in sustained phosphorylation of Akt/protein kinase B downstream of PI 3'-kinase, whereas p44/42 MAPK phosphorylation was decreased in response to chronic exposure to IGF-I. An IGF-I dose-dependent increase in the cyclin-dependent kinase inhibitor p21(Cip1/WAF1) was also observed over 24 h of treatment. Collectively, these data suggest that IGF-I is growth inhibitory to A549 cells, possibly via sustained activation of the PI 3'-kinase signaling pathway, and induction of p21(Cip1/WAF1).     

PI3K/CTGF信号通路在TGF-β1诱导A549细胞表达collagen I过程中的作用

 目的： 研究磷脂酰肌醇3-激酶/结缔组织生长因子（PI3K/CTGF）信号通路在转化生长因子β1（TGF-β1）诱导人肺腺癌A549细胞表达I型胶原蛋白（collagen I）过程中的分子机制。方法： 体外培养A549细胞,予TGF-β1刺激,观察CTGF和collagen I的mRNA和蛋白表达及PI3K信号通路的活化;PI3K抑制剂LY294002预先处理A549细胞后,观察TGF-β1刺激下CTGF和collagen I mRNA和蛋白表达的变化;CTGF特异性siRNA干扰A549细胞中CTGF的表达后,观察TGF-β1刺激下collagen I mRNA和蛋白表达的变化和PI3K信号通路的活化。结果： TGF-β1可以诱导A549细胞中CTGF和collagen I的mRNA和蛋白表达以及PI3K信号通路的活化;PI3K特异性抑制剂LY294002可以部分逆转TGF-β1诱导的A549细胞中CTGF和Collagen I mRNA和蛋白表达的升高。干扰CTGF可以降低TGF-β1诱导的A549细胞collagen I mRNA和蛋白表达,而不影响PI3K信号通路的活化。结论： CTGF是TGF-β1/PI3K信号通路调控的即刻早期反应效应蛋白,参与了TGF-β1诱导的A549细胞中collagen I表达。     

SPREDs (Sprouty Related Proteins with EVH1 Domain) promote self‐renewal and inhibit mesodermal differentiation in murine embryonic stem cells

Background : Pluripotency, self‐renewal, and differentiation are special features of embryonic stem (ES) cells, thereby providing valuable perspectives in regenerative medicine. Developmental processes require a fine‐tuned organization, mainly regulated by the well‐known JAK/STAT, PI3K/AKT, and ERK/MAPK pathways. SPREDs (Sprouty related proteins with EVH1 domain) were discovered as inhibitors of the ERK/MAPK signaling pathway, whereas nothing was known about their functions in ES cells and during early differentiation, so far. Results: We generated SPRED1 and SPRED2 overexpressing and SPRED2 knockout murine ES cells to analyze the functions of SPRED proteins in ES cells and during early differentiation. Overexpression of SPREDs increases significantly the self‐renewal and clonogenicity of murine ES cells, whereas lack of SPRED2 reduces proliferation and increases apoptosis. During early differentiation in embryoid bodies, SPREDs promote the pluripotent state and inhibit differentiation whereby mesodermal differentiation into cardiomyocytes is considerably delayed and inhibited. LIF‐ and growth factor‐stimulation revealed that SPREDs inhibit ERK/MAPK activation in murine ES cells. However, no effects were detectable on LIF‐induced activation of the JAK/STAT3, or PI3K/AKT signaling pathway by SPRED proteins. Conclusions: We show that SPREDs promote self‐renewal and inhibit mesodermal differentiation of murine ES cells by selective suppression of the ERK/MAPK signaling pathway in pluripotent cells. Developmental Dynamics 244:591–606, 2015. © 2015 Wiley Periodicals, Inc.     

肿瘤中磷脂酰肌醇信号系统的作用

磷脂酰肌醇信号系统是一个由酶、磷脂信使及其结合蛋白组成的复杂的细胞调节系统,对细胞的生长、增殖、存活以及细胞运动起着重要的调节作用。激活磷脂信使的酶若发生突变,将会导致磷脂酰肌醇信号系统高度激活,磷脂酰肌醇过度激活将会导致细胞增殖异常,胞吞胞吐异常以及细胞转移异常甚至肿瘤发生。由于磷脂酰肌醇信号系统在肿瘤增殖生长及其转移中的重要性,磷脂酰肌醇系统的各个组分很有可能成为好的临床治疗靶点,越来越多针对这一通路的药物逐步走向临床,磷脂酰肌醇3激酶（ PI3 K）抑制剂wortmannin、 LY294002等能够快速靶向PI3K,抑制肿瘤中AKT的磷酸化,阻止其对下游生长信号进行活化。 mTOR抑制剂rapamycin能够靶向mTOR,在非小细胞肺癌、乳腺癌、宫颈癌、肉瘤、淋巴瘤和胶质瘤等癌症中的治疗效果非常明显。除靶向药物外更有膜上的磷脂酰肌醇分布动态监测系统问世,为肿瘤的临床治疗提供新思路。     

Targeting the Phosphatidylinositol 3-Kinase Pathway in Airway Smooth Muscle

The phosphatidylinositol 3-kinase (PI3K) signaling pathway plays a critical role in regulating cell growth, proliferation, survival, and motility. Structural alterations, e.g. airway remodeling, in asthma and chronic obstructive pulmonary disease (COPD) are associated with increased airway smooth muscle (ASM) cell growth and proliferation due to the frequent stimulation of ASM by inflammatory mediators, contractile agonists, and growth factors. The critical role of the PI3K signaling pathway in regulating ASM cell growth and proliferation is well established. However, recent discovery of the tumor suppressor proteins tuberous sclerosis complex 1 (TSC1) and TSC2, also known as hamartin and tuberin, as downstream effectors of PI3K and upstream regulators of the mammalian target of rapamycin (mTOR) and S6 kinase 1(S6K1) shed a new light on the PI3K signaling cascade in regulating cell growth and proliferation. The activity of TSC1/TSC2 is regulated by growth factors, nutrients, and energy; thus, TSC1/TSC2 serves as a signaling module for protein translational regulation, cell cycle progression, and cell size, which are key events controlling cell growth and proliferation. This article highlights the potential contribution of the PI3K-TSC1/TSC2-mTOR/S6K1 pathway in smooth muscle remodeling. Pharmacologic manipulation of this signaling pathway could have a major impact on treatment of asthma and COPD.     

Infection with Anaplasma phagocytophilum activates the phosphatidylinositol 3-Kinase/Akt and NF-κB survival pathways in neutrophil granulocytes

Anaplasma phagocytophilum, a Gram-negative, obligate intracellular bacterium infects primarily neutrophil granulocytes. Infection with A. phagocytophilum leads to inhibition of neutrophil apoptosis and consequently contributes to the longevity of the host cells. Previous studies demonstrated that the infection inhibits the executionary apoptotic machinery in neutrophils. However, little attempt has been made to explore which survival signals are modulated by the pathogen. The aim of the present study was to clarify whether the phosphatidylinositol 3-kinase (PI3K)/Akt and NF-κB signaling pathways, which are considered as important survival pathways in neutrophils, are involved in A. phagocytophilum-induced apoptosis delay. Our data show that infection of neutrophils with A. phagocytophilum activates the PI3K/Akt pathway and suggest that this pathway, which in turn maintains the expression of the antiapoptotic protein Mcl-1, contributes to the infection-induced apoptosis delay. In addition, the PI3K/Akt pathway is involved in the activation of NF-κB in A. phagocytophilum-infected neutrophils. Activation of NF-κB leads to the release of interleukin-8 (IL-8) from infected neutrophils, which, in an autocrine manner, delays neutrophil apoptosis. In addition, enhanced expression of the antiapoptotic protein cIAP2 was observed in A. phagocytophilum-infected neutrophils. Taken together, the data indicate that upstream of the apoptotic cascade, signaling via the PI3K/Akt pathway plays a major role for apoptosis delay in A. phagocytophilum-infected neutrophils.     

Jagged1调控STAT3信号通路影响多发性骨髓瘤细胞的生长和凋亡

目的:研究Jagged1对多发性骨髓瘤细胞生长和凋亡的影响及其机制。方法:多发性骨髓瘤细胞U266转染Jagged1小干扰RNA和小干扰RNA阴性对照,RT-q PCR和Western blot检测细胞中的Jagged1水平,以不做转染的细胞为空白对照,台盼蓝染色,绘制细胞生长曲线,MTT检测细胞活力,流式细胞术检测细胞凋亡,Western blot检测细胞中信号转导及转录激活因子3(STAT3)、磷酸化STAT3(p-STAT3)和Bax的蛋白表达水平。用STAT3信号通路抑制剂AG490处理细胞,检测细胞中p-STAT3水平。AG490处理下调Jagged1表达后的U266细胞,MTT检测细胞活力,流式细胞术检测细胞凋亡。结果:与空白对照组细胞相比,转染Jagged1小干扰RNA后细胞中Jagged1的mRNA和蛋白水平下降(P0.05),而转染小干扰RNA阴性对照的细胞中Jagged1的mRNA和蛋白水平没有变化。与不做转染的细胞相比,敲减Jagged1表达的U266细胞生长速度降低,细胞活力降低,细胞凋亡率升高(P0.05)。与不做转染的细胞相比,敲减Jagged1表达的U266细胞中Bax水平升高,p-STAT3水平下降(P0.05)。AG490处理后的U266细胞p-STAT3水平下降,STAT3信号通路激活受阻。AG490可以促进下调Jagged1诱导的U266细胞凋亡,抑制细胞活力。结论:敲减Jagged1表达通过抑制STAT3信号通路促进多发性骨髓瘤细胞凋亡,抑制细胞生长。     

Significance of IL-6 in the transition of hormone-resistant prostate cancer and the induction of myeloid-derived suppressor cells

Hormone-resistant (HR) prostate cancers are highly aggressive and respond poorly to treatment. A better understanding of the molecular mechanisms involved in HR should lead to more rational approaches to therapy. The role of IL-6/STAT3 signaling in the transition of HR with aggressive tumor behavior and its possible link with myeloid-derived suppressor cells (MDSCs) were identified. In the present study, murine prostate cancer cell line (TRAMP-C1) and a hormone-resistant cell sub-line (TRAMP-HR) were used. Changes in tumor growth, invasion ability, and the responsible pathway were investigated in vitro and in vivo. We also examined the role of IL-6 in HR tumor progression and the recruitment of MDSCs. As seen in both in vitro and in vivo experiments, HR had aggressive tumor growth compared to TRAMP-C1. From mRNA and protein analysis, a higher expression of IL-6 associated with a more activated STAT3 was noted in HR tumor. When IL-6 signaling in prostate cancer was blocked, aggressive tumor behavior could be overcome. The underlying changes included decreased cell proliferation, less epithelial–mesenchymal transition, and decreased STAT3 activation. In addition to tumor progression, circulating IL-6 levels were significantly correlated with MDSC recruitment in vivo. Inhibition of IL-6 abrogated the recruitment of MDSCs in tumor- bearing mice, associated with slower tumor growth and attenuated angiogenesis. In conclusion, altered IL-6/STAT3 signaling is crucial in HR transition, aggressive behavior, and MDSC recruitment. These findings provide evidence for therapeutically targeting IL-6 signaling in prostate cancer.     

EB病毒潜伏膜蛋白1对鼻咽癌细胞增殖及STAT3信号通路的影响

目的:探讨EB病毒编码的潜伏膜蛋白1(LMP1)对人鼻咽癌细胞增殖及信号转导与转录活化因子3(STAT3)信号通路的影响.方法:体外培养人高分化鼻咽癌细胞系CNE1及转染了LMP1基因质粒的CNE1细胞(CNE1-GL细胞),通过绘制细胞生长曲线及平板克隆形成实验比较转染LMP1基因前后细胞增殖能力的变化;RT-PCR及免疫印迹方法检测STAT3及其下游基因survivin表达的变化.结果:转染LMP1基因后,CNE1细胞生长加快、克隆形成率增加;STAT3活化程度增加,survivin表达增强.结论:LMP1可促进CNE1细胞增殖,其机制可能是通过活化STAT3信号通路,进而促进抗凋亡基因survivin表达.     

PI3K/Akt和JAK2/STAT3信号转导通路在SO_2抗大鼠肢体缺血再灌注致急性肺损伤中的作用

目的:探讨PI3K/Akt和JAK2/STAT3信号转导通路在二氧化硫(SO2)抗肢体缺血再灌注(I/R)致急性肺损伤中的作用。方法:应用双大腿根部绑扎止血带复制大鼠双后肢缺血再灌注肺损伤模型。在再灌注前20 min腹腔注射Na2SO3/Na HSO3;在再灌注前1 h静脉注射Stattic或LY294002。应用TUNEL、ELISA、Western blot等方法检测细胞凋亡、细胞因子表达及相关信号通路蛋白表达的情况。结果:与对照组相比,I/R组的MDA及MPO含量、肺系数、细胞凋亡指数、细胞因子表达以及p-STAT3、p-Akt蛋白的水平均显著增高;当应用Na2SO3/Na HSO3后,上述反映肺损伤的各项指标均下降。Western blot检测结果显示I/R后,肺组织中p-STAT3和p-Akt蛋白的水平均明显增加。而应用Na2SO3/Na HSO3后,p-Akt蛋白的水平继续增加,但p-STAT3蛋白的水平却减少(P0.05)。结论:JAK2/STAT3和PI3K/Akt信号通路都参与了SO2抗肢体缺血再灌注致急性肺损伤的作用。JAK2/STAT3通路的活化,能够使I/R损伤加重;相反,PI3K/Akt信号通路的活化,可以使I/R损伤减弱。此外,JAK2/STAT3和PI3K/Akt信号通路之间存在交互作用。     

BCR Signaling in Chronic Lymphocytic Leukemia and Related Inhibitors Currently in Clinical Studies

Normal B lymphocytes receive signals from B-cell antigen receptor (BCR) that are triggered by binding of the BCR to an external antigen. Tonic signaling through the BCR provides growth and signals to chronic lymphocytic leukemia (CLL) cells, and plays an important role in the pathogenesis and progression of the disease. Antigen engagement of BCR is followed by intracellular recruitment and activation of BCR-associated kinases including spleen tyrosine kinase (Syk), Bruton's tyrosine kinase (Btk) and phosphatidylinositol 3-kinases (PI3K). Inhibition of signaling pathways downstream of the BCR induces disruption of chemokine-mediated CLL cell migration and cell killing. BCR signal transduction inhibitors represent a promising new strategy for targeted CLL treatment. A number of therapeutic agents have recently been developed with significant activity in CLL. The compounds that are currently investigated in patients with CLL include ibrutinib –inhibitor of Btk, fostamatinib-inhibitor of Syk and idelalisib (GS-1101) –a specific isoform of the PI3K (PI3K) inhibitor. The clinical activity of ibrutinib, GS-1101 and fostamatinib in patients with CLL is associated with marked lymphocytosis due to release of tumor cells from the lymph nodes into the peripheral blood. Further studies are ongoing with single agents and their combinations with other targeted and conventional therapies. This article will review the preclinical rationale of BCR signaling inhibitors in the treatment of CLL, and the clinical evidence supporting the use of these agents in CLL patients.     

Selective Inhibition of PI3K Isoforms in Brain Tumors Suppresses Tumor Growth by Increasing Radiosensitivity

PurposeGlioblastoma (GBM) is a malignant brain tumor with poor prognosis. Radioresistance is a major challenge in the treatment of brain tumors. The development of several types of tumors, including GBM, involves the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. Upon activation, this pathway induces radioresistance. In this study, we investigated whether additional use of selective inhibitors of PI3K isoforms would enhance radiosensitivity in GBM.Materials and MethodsWe evaluated whether radiation combined with PI3K isoform selective inhibitors can suppress radioresistance in GBM. Glioma 261 expressing luciferase (GL261-luc) and LN229 were used to confirm the effect of combination of radiation and PI3K isoform inhibitors in vitro. Cell viability was confirmed by clonogenic assay, and inhibition of PI3K/AKT signaling activation was observed by Western blot. To confirm radiosensitivity, the expression of phospho-γ-H2AX was observed by immunofluorescence. In addition, to identify the effect of a combination of radiation and PI3K-α isoform inhibitor in vivo, an intracranial mouse model was established by implanting GL261-luc. Tumor growth was observed by IVIS imaging, and survival was analyzed using Kaplan–Meier survival curves.ResultsSuppression of the PI3K/AKT signaling pathway increased radiosensitivity, and PI3K-α inhibition had similar effects on PI3K-pan inhibition in vitro. The combination of radiotherapy and PI3K-α isoform inhibitor suppressed tumor growth and extended survival in vivo.ConclusionThis study verified that PI3K-α isoform inhibition improves radiosensitivity, resulting in tumor growth suppression and extended survival in GBM mice.     

STAT3 regulates ABCA3 expression and influences lamellar body formation in alveolar type II cells

ATP-Binding Cassette A3 (ABCA3) is a lamellar body associated lipid transport protein required for normal synthesis and storage of pulmonary surfactant in type II cells in the alveoli. In this study, we demonstrate that STAT3, activated by IL-6, regulates ABCA3 expression in vivo and in vitro. ABCA3 mRNA and immunostaining were decreased in adult mouse lungs in which STAT3 was deleted from the respiratory epithelium (Stat3(Delta/Delta) mice). Consistent with the role of STAT3, intratracheal IL-6 induced ABCA3 expression in vivo. Decreased ABCA3 and abnormalities in the formation of lamellar bodies, the intracellular site of surfactant lipid storage, were observed in Stat3(Delta/Delta) mice. Expression of SREBP1a and 1c, SCAP, ABCA3, and AKT mRNAs was inhibited by deletion of Stat3 in type II cells isolated from Stat3(Delta/Delta) mice. The activities of PI3K and AKT were required for normal Abca3 gene expression in vitro. AKT activation induced SREBP expression and increased the activity of the Abca3 promoter in vitro, consistent with the role of STAT3 signaling, at least in part via SREBP, in the regulation of ABCA3. ABCA3 expression is regulated by IL-6 in a pathway that includes STAT3, PI3K, AKT, SCAP, and SREBP. Activation of STAT3 after exposure to IL-6 enhances ABCA3 expression, which, in turn, influences pulmonary surfactant homeostasis.     

Interfering with resistance to smoothened antagonists by inhibition of the PI3K pathway in medulloblastoma

The malignant brain cancer medulloblastoma is characterized by mutations in Hedgehog (Hh) signaling pathway genes, which lead to constitutive activation of the G protein (heterotrimeric guanosine triphosphate-binding protein)-coupled receptor Smoothened (Smo). The Smo antagonist NVP-LDE225 inhibits Hh signaling and induces tumor regression in animal models of medulloblastoma. However, evidence of resistance was observed during the course of treatment. Molecular analysis of resistant tumors revealed several resistance mechanisms. We noted chromosomal amplification of Gli2, a downstream effector of Hh signaling, and, more rarely, point mutations in Smo that led to reactivated Hh signaling and restored tumor growth. Analysis of pathway gene expression signatures also, unexpectedly, identified up-regulation of phosphatidylinositol 3-kinase (PI3K) signaling in resistant tumors as another potential mechanism of resistance. Probing the relevance of increased PI3K signaling, we demonstrated that addition of the PI3K inhibitor NVP-BKM120 or the dual PI3K-mTOR (mammalian target of rapamycin) inhibitor NVP-BEZ235 to the initial treatment with the Smo antagonist markedly delayed the development of resistance. Our findings may be useful in informing treatment strategies for medulloblastoma.